1023 lines
32 KiB
Python
1023 lines
32 KiB
Python
# """
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# Viewflow workflows for billing app.
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# Provides medical billing, insurance claims, and payment processing workflows.
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# """
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#
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# from viewflow import Flow, lock
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# from viewflow.base import this, flow_func
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# from viewflow.contrib import celery
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# from viewflow.decorators import flow_view
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# from viewflow.fields import CharField, ModelField
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# from viewflow.forms import ModelForm
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# from viewflow.views import CreateProcessView, UpdateProcessView
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# from viewflow.models import Process, Task
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# from django.contrib.auth.models import User
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# from django.urls import reverse_lazy
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# from django.utils import timezone
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# from django.db import transaction
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# from django.core.mail import send_mail
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#
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# from .models import MedicalBill, InsuranceClaim, Payment, ClaimStatusUpdate
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# from .views import (
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# BillGenerationView, ChargeReviewView, InsuranceVerificationView,
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# ClaimPreparationView, ClaimSubmissionView, ClaimTrackingView,
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# PaymentProcessingView, PaymentReconciliationView, DenialManagementView,
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# AppealPreparationView, CollectionsView
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# )
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#
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#
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# class MedicalBillingProcess(Process):
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# """
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# Viewflow process model for medical billing
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# """
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# medical_bill = ModelField(MedicalBill, help_text='Associated medical bill')
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#
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# # Process status tracking
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# charges_captured = models.BooleanField(default=False)
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# charges_reviewed = models.BooleanField(default=False)
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# insurance_verified = models.BooleanField(default=False)
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# bill_generated = models.BooleanField(default=False)
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# claims_submitted = models.BooleanField(default=False)
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# payments_processed = models.BooleanField(default=False)
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# account_reconciled = models.BooleanField(default=False)
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# billing_completed = models.BooleanField(default=False)
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#
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# class Meta:
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# verbose_name = 'Medical Billing Process'
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# verbose_name_plural = 'Medical Billing Processes'
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#
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#
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# class MedicalBillingFlow(Flow):
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# """
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# Medical Billing Workflow
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#
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# This flow manages the complete revenue cycle from charge capture
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# through payment processing and account reconciliation.
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# """
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#
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# process_class = MedicalBillingProcess
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#
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# # Flow definition
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# start = (
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# flow_func(this.start_billing)
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# .Next(this.capture_charges)
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# )
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#
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# capture_charges = (
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# flow_func(this.collect_service_charges)
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# .Next(this.review_charges)
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# )
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#
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# review_charges = (
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# flow_view(ChargeReviewView)
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# .Permission('billing.can_review_charges')
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# .Next(this.verify_insurance)
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# )
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#
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# verify_insurance = (
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# flow_view(InsuranceVerificationView)
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# .Permission('billing.can_verify_insurance')
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# .Next(this.generate_bill)
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# )
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#
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# generate_bill = (
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# flow_view(BillGenerationView)
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# .Permission('billing.can_generate_bills')
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# .Next(this.parallel_claim_processing)
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# )
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#
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# parallel_claim_processing = (
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# flow_func(this.start_parallel_processing)
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# .Next(this.submit_primary_claim)
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# .Next(this.submit_secondary_claim)
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# .Next(this.patient_billing)
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# )
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#
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# submit_primary_claim = (
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# flow_view(PrimaryClaimSubmissionView)
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# .Permission('billing.can_submit_claims')
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# .Next(this.join_claim_processing)
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# )
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#
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# submit_secondary_claim = (
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# flow_view(SecondaryClaimSubmissionView)
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# .Permission('billing.can_submit_claims')
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# .Next(this.join_claim_processing)
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# )
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#
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# patient_billing = (
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# flow_view(PatientBillingView)
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# .Permission('billing.can_bill_patients')
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# .Next(this.join_claim_processing)
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# )
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#
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# join_claim_processing = (
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# flow_func(this.join_parallel_processing)
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# .Next(this.process_payments)
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# )
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#
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# process_payments = (
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# flow_view(PaymentProcessingView)
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# .Permission('billing.can_process_payments')
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# .Next(this.reconcile_account)
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# )
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#
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# reconcile_account = (
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# flow_view(PaymentReconciliationView)
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# .Permission('billing.can_reconcile_accounts')
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# .Next(this.finalize_billing)
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# )
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#
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# finalize_billing = (
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# flow_func(this.complete_billing)
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# .Next(this.end)
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# )
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#
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# end = flow_func(this.end_billing)
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#
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# # Flow functions
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# def start_billing(self, activation):
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# """Initialize the billing process"""
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# process = activation.process
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# bill = process.medical_bill
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#
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# # Update bill status
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# bill.status = 'PROCESSING'
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# bill.save()
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#
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# # Send notification to billing staff
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# self.notify_billing_staff(bill)
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#
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# # Check for priority billing
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# if bill.bill_type in ['EMERGENCY', 'SURGERY']:
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# self.notify_priority_billing(bill)
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#
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# def collect_service_charges(self, activation):
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# """Collect charges from various service departments"""
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# process = activation.process
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# bill = process.medical_bill
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#
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# # Collect charges from different departments
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# charges = self.gather_service_charges(bill)
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#
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# if charges:
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# # Update bill with collected charges
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# self.update_bill_charges(bill, charges)
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#
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# process.charges_captured = True
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# process.save()
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#
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# def start_parallel_processing(self, activation):
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# """Start parallel claim and billing processing"""
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# process = activation.process
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#
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# # Create parallel processing tasks
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# self.create_claim_tasks(process.medical_bill)
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#
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# def join_parallel_processing(self, activation):
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# """Wait for all claim processing to complete"""
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# process = activation.process
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#
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# # Check if all processing is completed
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# if self.all_claims_processed(process.medical_bill):
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# # Proceed to payment processing
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# self.notify_claims_completed(process.medical_bill)
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#
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# def complete_billing(self, activation):
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# """Finalize the billing process"""
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# process = activation.process
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# bill = process.medical_bill
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#
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# # Update bill status based on payment status
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# if bill.balance_due <= 0:
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# bill.status = 'PAID'
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# elif bill.total_payments > 0:
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# bill.status = 'PARTIALLY_PAID'
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# else:
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# bill.status = 'OUTSTANDING'
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#
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# bill.save()
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#
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# # Mark process as completed
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# process.billing_completed = True
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# process.save()
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#
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# # Send completion notifications
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# self.notify_billing_completion(bill)
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#
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# # Update revenue metrics
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# self.update_revenue_metrics(bill)
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#
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# def end_billing(self, activation):
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# """End the billing workflow"""
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# process = activation.process
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#
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# # Generate billing summary report
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# self.generate_billing_summary(process.medical_bill)
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#
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# # Helper methods
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# def notify_billing_staff(self, bill):
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# """Notify billing staff of new bill"""
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# from django.contrib.auth.models import Group
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#
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# billing_staff = User.objects.filter(
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# groups__name='Billing Staff'
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# )
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#
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# for staff in billing_staff:
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# send_mail(
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# subject=f'New Medical Bill: {bill.bill_number}',
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# message=f'New medical bill for {bill.patient.get_full_name()} requires processing.',
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# from_email='billing@hospital.com',
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# recipient_list=[staff.email],
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# fail_silently=True
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# )
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#
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# def notify_priority_billing(self, bill):
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# """Notify of priority billing"""
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# billing_managers = User.objects.filter(
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# groups__name='Billing Managers'
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# )
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#
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# for manager in billing_managers:
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# send_mail(
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# subject=f'PRIORITY Billing: {bill.bill_number}',
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# message=f'{bill.get_bill_type_display()} bill requires priority processing.',
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# from_email='billing@hospital.com',
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# recipient_list=[manager.email],
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# fail_silently=True
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# )
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#
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# def gather_service_charges(self, bill):
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# """Gather charges from service departments"""
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# # This would collect charges from various departments
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# return []
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#
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# def update_bill_charges(self, bill, charges):
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# """Update bill with collected charges"""
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# # This would update the bill with charges
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# pass
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#
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# def create_claim_tasks(self, bill):
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# """Create claim processing tasks"""
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# # This would create tasks for claim processing
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# pass
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#
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# def all_claims_processed(self, bill):
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# """Check if all claims are processed"""
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# # This would check claim processing status
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# return True
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#
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# def notify_claims_completed(self, bill):
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# """Notify that claims processing is completed"""
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# billing_staff = User.objects.filter(
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# groups__name='Billing Staff'
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# )
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#
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# for staff in billing_staff:
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# send_mail(
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# subject=f'Claims Processed: {bill.bill_number}',
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# message=f'All claims have been processed for {bill.patient.get_full_name()}.',
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# from_email='billing@hospital.com',
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# recipient_list=[staff.email],
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# fail_silently=True
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# )
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#
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# def notify_billing_completion(self, bill):
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# """Notify billing completion"""
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# # Notify patient if email available
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# if bill.patient.email:
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# send_mail(
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# subject='Medical Bill Processed',
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# message=f'Your medical bill {bill.bill_number} has been processed.',
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# from_email='billing@hospital.com',
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# recipient_list=[bill.patient.email],
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# fail_silently=True
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# )
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#
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# def update_revenue_metrics(self, bill):
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# """Update revenue cycle metrics"""
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# # This would update revenue metrics
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# pass
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#
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# def generate_billing_summary(self, bill):
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# """Generate billing summary report"""
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# # This would generate a comprehensive billing report
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# pass
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#
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#
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# class InsuranceClaimProcess(Process):
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# """
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# Viewflow process model for insurance claims
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# """
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# insurance_claim = ModelField(InsuranceClaim, help_text='Associated insurance claim')
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#
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# # Process status tracking
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# claim_prepared = models.BooleanField(default=False)
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# eligibility_verified = models.BooleanField(default=False)
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# claim_submitted = models.BooleanField(default=False)
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# claim_tracked = models.BooleanField(default=False)
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# response_received = models.BooleanField(default=False)
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# payment_posted = models.BooleanField(default=False)
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# denials_managed = models.BooleanField(default=False)
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# claim_finalized = models.BooleanField(default=False)
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#
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# class Meta:
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# verbose_name = 'Insurance Claim Process'
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# verbose_name_plural = 'Insurance Claim Processes'
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#
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#
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# class InsuranceClaimFlow(Flow):
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# """
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# Insurance Claim Processing Workflow
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#
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# This flow manages insurance claim processing from preparation
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# through payment posting and denial management.
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# """
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#
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# process_class = InsuranceClaimProcess
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#
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# # Flow definition
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# start = (
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# flow_func(this.start_claim)
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# .Next(this.prepare_claim)
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# )
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#
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# prepare_claim = (
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# flow_view(ClaimPreparationView)
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# .Permission('billing.can_prepare_claims')
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# .Next(this.verify_eligibility)
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# )
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#
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# verify_eligibility = (
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# flow_view(EligibilityVerificationView)
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# .Permission('billing.can_verify_eligibility')
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# .Next(this.submit_claim)
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# )
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#
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# submit_claim = (
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# flow_view(ClaimSubmissionView)
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# .Permission('billing.can_submit_claims')
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# .Next(this.track_claim)
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# )
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#
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# track_claim = (
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# flow_view(ClaimTrackingView)
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# .Permission('billing.can_track_claims')
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# .Next(this.receive_response)
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# )
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#
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# receive_response = (
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# flow_func(this.process_claim_response)
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# .Next(this.post_payment)
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# )
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#
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# post_payment = (
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# flow_view(PaymentPostingView)
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# .Permission('billing.can_post_payments')
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# .Next(this.manage_denials)
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# )
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#
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# manage_denials = (
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# flow_view(DenialManagementView)
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# .Permission('billing.can_manage_denials')
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# .Next(this.finalize_claim)
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# )
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#
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# finalize_claim = (
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# flow_func(this.complete_claim)
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# .Next(this.end)
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# )
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#
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# end = flow_func(this.end_claim)
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#
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# # Flow functions
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# def start_claim(self, activation):
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# """Initialize the claim process"""
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# process = activation.process
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# claim = process.insurance_claim
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#
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# # Update claim status
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# claim.status = 'PREPARING'
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# claim.save()
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#
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# # Send notification to claims staff
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# self.notify_claims_staff(claim)
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#
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# def process_claim_response(self, activation):
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# """Process insurance claim response"""
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# process = activation.process
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# claim = process.insurance_claim
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#
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# # Check for claim response
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# response = self.check_claim_response(claim)
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#
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# if response:
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# # Update claim with response
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# self.update_claim_response(claim, response)
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#
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# process.response_received = True
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# process.save()
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#
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# # Handle different response types
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# if response.get('status') == 'DENIED':
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# self.handle_claim_denial(claim, response)
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# elif response.get('status') == 'PAID':
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# self.handle_claim_payment(claim, response)
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#
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# def complete_claim(self, activation):
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# """Finalize the claim process"""
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# process = activation.process
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# claim = process.insurance_claim
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#
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# # Update claim status based on final outcome
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# if claim.paid_amount >= claim.billed_amount:
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# claim.status = 'PAID'
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# elif claim.paid_amount > 0:
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# claim.status = 'PARTIALLY_PAID'
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# elif claim.denial_reason:
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# claim.status = 'DENIED'
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# else:
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# claim.status = 'PENDING'
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#
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# claim.save()
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#
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# # Mark process as completed
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# process.claim_finalized = True
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# process.save()
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#
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# # Send completion notifications
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# self.notify_claim_completion(claim)
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#
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# def end_claim(self, activation):
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# """End the claim workflow"""
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# process = activation.process
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#
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# # Generate claim summary report
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# self.generate_claim_summary(process.insurance_claim)
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#
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# # Helper methods
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# def notify_claims_staff(self, claim):
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# """Notify claims staff"""
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# claims_staff = User.objects.filter(
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# groups__name='Claims Staff'
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# )
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#
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# for staff in claims_staff:
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# send_mail(
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# subject=f'New Insurance Claim: {claim.claim_number}',
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# message=f'New insurance claim for {claim.patient.get_full_name()} requires processing.',
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# from_email='claims@hospital.com',
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# recipient_list=[staff.email],
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# fail_silently=True
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# )
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#
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# def check_claim_response(self, claim):
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# """Check for claim response from insurance"""
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# # This would check for insurance responses
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# return None
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#
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# def update_claim_response(self, claim, response):
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# """Update claim with insurance response"""
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# # This would update the claim with response data
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# pass
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#
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# def handle_claim_denial(self, claim, response):
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# """Handle claim denial"""
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|
# # Notify claims staff of denial
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# claims_staff = User.objects.filter(
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# groups__name='Claims Staff'
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# )
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#
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# for staff in claims_staff:
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# send_mail(
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# subject=f'Claim Denied: {claim.claim_number}',
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# message=f'Insurance claim has been denied. Reason: {response.get("denial_reason", "Unknown")}',
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# from_email='claims@hospital.com',
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# recipient_list=[staff.email],
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# fail_silently=True
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# )
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#
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# def handle_claim_payment(self, claim, response):
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# """Handle claim payment"""
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# # This would process claim payment
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# pass
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#
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# def notify_claim_completion(self, claim):
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# """Notify claim completion"""
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# # This would notify relevant parties
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# pass
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#
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# def generate_claim_summary(self, claim):
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# """Generate claim summary report"""
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# # This would generate claim summary
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# pass
|
|
#
|
|
#
|
|
# class PaymentProcessingProcess(Process):
|
|
# """
|
|
# Viewflow process model for payment processing
|
|
# """
|
|
# payment = ModelField(Payment, help_text='Associated payment')
|
|
#
|
|
# # Process status tracking
|
|
# payment_received = models.BooleanField(default=False)
|
|
# payment_verified = models.BooleanField(default=False)
|
|
# payment_processed = models.BooleanField(default=False)
|
|
# payment_deposited = models.BooleanField(default=False)
|
|
# account_updated = models.BooleanField(default=False)
|
|
# receipt_generated = models.BooleanField(default=False)
|
|
# payment_completed = models.BooleanField(default=False)
|
|
#
|
|
# class Meta:
|
|
# verbose_name = 'Payment Processing Process'
|
|
# verbose_name_plural = 'Payment Processing Processes'
|
|
#
|
|
#
|
|
# class PaymentProcessingFlow(Flow):
|
|
# """
|
|
# Payment Processing Workflow
|
|
#
|
|
# This flow manages payment processing from receipt through
|
|
# deposit and account reconciliation.
|
|
# """
|
|
#
|
|
# process_class = PaymentProcessingProcess
|
|
#
|
|
# # Flow definition
|
|
# start = (
|
|
# flow_func(this.start_payment)
|
|
# .Next(this.receive_payment)
|
|
# )
|
|
#
|
|
# receive_payment = (
|
|
# flow_view(PaymentReceiptView)
|
|
# .Permission('billing.can_receive_payments')
|
|
# .Next(this.verify_payment)
|
|
# )
|
|
#
|
|
# verify_payment = (
|
|
# flow_view(PaymentVerificationView)
|
|
# .Permission('billing.can_verify_payments')
|
|
# .Next(this.process_payment)
|
|
# )
|
|
#
|
|
# process_payment = (
|
|
# flow_view(PaymentProcessingView)
|
|
# .Permission('billing.can_process_payments')
|
|
# .Next(this.deposit_payment)
|
|
# )
|
|
#
|
|
# deposit_payment = (
|
|
# flow_view(PaymentDepositView)
|
|
# .Permission('billing.can_deposit_payments')
|
|
# .Next(this.update_account)
|
|
# )
|
|
#
|
|
# update_account = (
|
|
# flow_func(this.update_patient_account)
|
|
# .Next(this.generate_receipt)
|
|
# )
|
|
#
|
|
# generate_receipt = (
|
|
# flow_view(ReceiptGenerationView)
|
|
# .Permission('billing.can_generate_receipts')
|
|
# .Next(this.finalize_payment)
|
|
# )
|
|
#
|
|
# finalize_payment = (
|
|
# flow_func(this.complete_payment)
|
|
# .Next(this.end)
|
|
# )
|
|
#
|
|
# end = flow_func(this.end_payment)
|
|
#
|
|
# # Flow functions
|
|
# def start_payment(self, activation):
|
|
# """Initialize the payment process"""
|
|
# process = activation.process
|
|
# payment = process.payment
|
|
#
|
|
# # Update payment status
|
|
# payment.status = 'PENDING'
|
|
# payment.save()
|
|
#
|
|
# # Send notification to billing staff
|
|
# self.notify_payment_received(payment)
|
|
#
|
|
# def update_patient_account(self, activation):
|
|
# """Update patient account with payment"""
|
|
# process = activation.process
|
|
# payment = process.payment
|
|
#
|
|
# # Update medical bill balance
|
|
# bill = payment.medical_bill
|
|
# bill.total_payments += payment.payment_amount
|
|
# bill.balance_due = bill.total_amount - bill.total_payments
|
|
# bill.save()
|
|
#
|
|
# process.account_updated = True
|
|
# process.save()
|
|
#
|
|
# # Check if bill is fully paid
|
|
# if bill.balance_due <= 0:
|
|
# self.notify_account_paid_in_full(bill)
|
|
#
|
|
# def complete_payment(self, activation):
|
|
# """Finalize the payment process"""
|
|
# process = activation.process
|
|
# payment = process.payment
|
|
#
|
|
# # Update payment status
|
|
# payment.status = 'PROCESSED'
|
|
# payment.save()
|
|
#
|
|
# # Mark process as completed
|
|
# process.payment_completed = True
|
|
# process.save()
|
|
#
|
|
# # Send completion notifications
|
|
# self.notify_payment_completion(payment)
|
|
#
|
|
# def end_payment(self, activation):
|
|
# """End the payment workflow"""
|
|
# process = activation.process
|
|
#
|
|
# # Generate payment summary report
|
|
# self.generate_payment_summary(process.payment)
|
|
#
|
|
# # Helper methods
|
|
# def notify_payment_received(self, payment):
|
|
# """Notify billing staff of payment received"""
|
|
# billing_staff = User.objects.filter(
|
|
# groups__name='Billing Staff'
|
|
# )
|
|
#
|
|
# for staff in billing_staff:
|
|
# send_mail(
|
|
# subject=f'Payment Received: {payment.payment_number}',
|
|
# message=f'Payment of ${payment.payment_amount} received for {payment.patient.get_full_name()}.',
|
|
# from_email='billing@hospital.com',
|
|
# recipient_list=[staff.email],
|
|
# fail_silently=True
|
|
# )
|
|
#
|
|
# def notify_account_paid_in_full(self, bill):
|
|
# """Notify that account is paid in full"""
|
|
# # Notify patient
|
|
# if bill.patient.email:
|
|
# send_mail(
|
|
# subject='Account Paid in Full',
|
|
# message=f'Your account for bill {bill.bill_number} has been paid in full.',
|
|
# from_email='billing@hospital.com',
|
|
# recipient_list=[bill.patient.email],
|
|
# fail_silently=True
|
|
# )
|
|
#
|
|
# def notify_payment_completion(self, payment):
|
|
# """Notify payment completion"""
|
|
# # This would notify relevant parties
|
|
# pass
|
|
#
|
|
# def generate_payment_summary(self, payment):
|
|
# """Generate payment summary report"""
|
|
# # This would generate payment summary
|
|
# pass
|
|
#
|
|
#
|
|
# class DenialManagementProcess(Process):
|
|
# """
|
|
# Viewflow process model for denial management
|
|
# """
|
|
# insurance_claim = ModelField(InsuranceClaim, help_text='Associated denied claim')
|
|
#
|
|
# # Process status tracking
|
|
# denial_analyzed = models.BooleanField(default=False)
|
|
# appeal_prepared = models.BooleanField(default=False)
|
|
# appeal_submitted = models.BooleanField(default=False)
|
|
# appeal_tracked = models.BooleanField(default=False)
|
|
# appeal_resolved = models.BooleanField(default=False)
|
|
# account_adjusted = models.BooleanField(default=False)
|
|
# denial_completed = models.BooleanField(default=False)
|
|
#
|
|
# class Meta:
|
|
# verbose_name = 'Denial Management Process'
|
|
# verbose_name_plural = 'Denial Management Processes'
|
|
#
|
|
#
|
|
# class DenialManagementFlow(Flow):
|
|
# """
|
|
# Denial Management Workflow
|
|
#
|
|
# This flow manages insurance claim denials including analysis,
|
|
# appeal preparation, submission, and resolution.
|
|
# """
|
|
#
|
|
# process_class = DenialManagementProcess
|
|
#
|
|
# # Flow definition
|
|
# start = (
|
|
# flow_func(this.start_denial_management)
|
|
# .Next(this.analyze_denial)
|
|
# )
|
|
#
|
|
# analyze_denial = (
|
|
# flow_view(DenialAnalysisView)
|
|
# .Permission('billing.can_analyze_denials')
|
|
# .Next(this.prepare_appeal)
|
|
# )
|
|
#
|
|
# prepare_appeal = (
|
|
# flow_view(AppealPreparationView)
|
|
# .Permission('billing.can_prepare_appeals')
|
|
# .Next(this.submit_appeal)
|
|
# )
|
|
#
|
|
# submit_appeal = (
|
|
# flow_view(AppealSubmissionView)
|
|
# .Permission('billing.can_submit_appeals')
|
|
# .Next(this.track_appeal)
|
|
# )
|
|
#
|
|
# track_appeal = (
|
|
# flow_view(AppealTrackingView)
|
|
# .Permission('billing.can_track_appeals')
|
|
# .Next(this.resolve_appeal)
|
|
# )
|
|
#
|
|
# resolve_appeal = (
|
|
# flow_func(this.process_appeal_resolution)
|
|
# .Next(this.adjust_account)
|
|
# )
|
|
#
|
|
# adjust_account = (
|
|
# flow_view(AccountAdjustmentView)
|
|
# .Permission('billing.can_adjust_accounts')
|
|
# .Next(this.finalize_denial)
|
|
# )
|
|
#
|
|
# finalize_denial = (
|
|
# flow_func(this.complete_denial_management)
|
|
# .Next(this.end)
|
|
# )
|
|
#
|
|
# end = flow_func(this.end_denial_management)
|
|
#
|
|
# # Flow functions
|
|
# def start_denial_management(self, activation):
|
|
# """Initialize the denial management process"""
|
|
# process = activation.process
|
|
# claim = process.insurance_claim
|
|
#
|
|
# # Send notification to denial management staff
|
|
# self.notify_denial_staff(claim)
|
|
#
|
|
# def process_appeal_resolution(self, activation):
|
|
# """Process appeal resolution"""
|
|
# process = activation.process
|
|
# claim = process.insurance_claim
|
|
#
|
|
# # Check appeal status
|
|
# appeal_result = self.check_appeal_status(claim)
|
|
#
|
|
# if appeal_result:
|
|
# # Update claim with appeal result
|
|
# self.update_appeal_result(claim, appeal_result)
|
|
#
|
|
# process.appeal_resolved = True
|
|
# process.save()
|
|
#
|
|
# def complete_denial_management(self, activation):
|
|
# """Finalize the denial management process"""
|
|
# process = activation.process
|
|
# claim = process.insurance_claim
|
|
#
|
|
# # Mark process as completed
|
|
# process.denial_completed = True
|
|
# process.save()
|
|
#
|
|
# # Send completion notifications
|
|
# self.notify_denial_completion(claim)
|
|
#
|
|
# def end_denial_management(self, activation):
|
|
# """End the denial management workflow"""
|
|
# process = activation.process
|
|
#
|
|
# # Generate denial management summary
|
|
# self.generate_denial_summary(process.insurance_claim)
|
|
#
|
|
# # Helper methods
|
|
# def notify_denial_staff(self, claim):
|
|
# """Notify denial management staff"""
|
|
# denial_staff = User.objects.filter(
|
|
# groups__name='Denial Management'
|
|
# )
|
|
#
|
|
# for staff in denial_staff:
|
|
# send_mail(
|
|
# subject=f'Claim Denial: {claim.claim_number}',
|
|
# message=f'Insurance claim has been denied and requires review.',
|
|
# from_email='denials@hospital.com',
|
|
# recipient_list=[staff.email],
|
|
# fail_silently=True
|
|
# )
|
|
#
|
|
# def check_appeal_status(self, claim):
|
|
# """Check appeal status"""
|
|
# # This would check appeal status
|
|
# return None
|
|
#
|
|
# def update_appeal_result(self, claim, result):
|
|
# """Update claim with appeal result"""
|
|
# # This would update the claim with appeal result
|
|
# pass
|
|
#
|
|
# def notify_denial_completion(self, claim):
|
|
# """Notify denial management completion"""
|
|
# # This would notify relevant parties
|
|
# pass
|
|
#
|
|
# def generate_denial_summary(self, claim):
|
|
# """Generate denial management summary"""
|
|
# # This would generate denial summary
|
|
# pass
|
|
#
|
|
#
|
|
# class CollectionsProcess(Process):
|
|
# """
|
|
# Viewflow process model for collections
|
|
# """
|
|
# medical_bill = ModelField(MedicalBill, help_text='Associated medical bill')
|
|
#
|
|
# # Process status tracking
|
|
# account_reviewed = models.BooleanField(default=False)
|
|
# patient_contacted = models.BooleanField(default=False)
|
|
# payment_plan_offered = models.BooleanField(default=False)
|
|
# collection_actions_taken = models.BooleanField(default=False)
|
|
# external_agency_assigned = models.BooleanField(default=False)
|
|
# collections_resolved = models.BooleanField(default=False)
|
|
#
|
|
# class Meta:
|
|
# verbose_name = 'Collections Process'
|
|
# verbose_name_plural = 'Collections Processes'
|
|
#
|
|
#
|
|
# class CollectionsFlow(Flow):
|
|
# """
|
|
# Collections Workflow
|
|
#
|
|
# This flow manages collections activities for overdue accounts
|
|
# including patient contact, payment plans, and external collections.
|
|
# """
|
|
#
|
|
# process_class = CollectionsProcess
|
|
#
|
|
# # Flow definition
|
|
# start = (
|
|
# flow_func(this.start_collections)
|
|
# .Next(this.review_account)
|
|
# )
|
|
#
|
|
# review_account = (
|
|
# flow_view(AccountReviewView)
|
|
# .Permission('billing.can_review_collections')
|
|
# .Next(this.contact_patient)
|
|
# )
|
|
#
|
|
# contact_patient = (
|
|
# flow_view(PatientContactView)
|
|
# .Permission('billing.can_contact_patients')
|
|
# .Next(this.offer_payment_plan)
|
|
# )
|
|
#
|
|
# offer_payment_plan = (
|
|
# flow_view(PaymentPlanView)
|
|
# .Permission('billing.can_offer_payment_plans')
|
|
# .Next(this.collection_actions)
|
|
# )
|
|
#
|
|
# collection_actions = (
|
|
# flow_view(CollectionActionsView)
|
|
# .Permission('billing.can_take_collection_actions')
|
|
# .Next(this.external_collections)
|
|
# )
|
|
#
|
|
# external_collections = (
|
|
# flow_view(ExternalCollectionsView)
|
|
# .Permission('billing.can_assign_external_collections')
|
|
# .Next(this.resolve_collections)
|
|
# )
|
|
#
|
|
# resolve_collections = (
|
|
# flow_func(this.complete_collections)
|
|
# .Next(this.end)
|
|
# )
|
|
#
|
|
# end = flow_func(this.end_collections)
|
|
#
|
|
# # Flow functions
|
|
# def start_collections(self, activation):
|
|
# """Initialize the collections process"""
|
|
# process = activation.process
|
|
# bill = process.medical_bill
|
|
#
|
|
# # Send notification to collections staff
|
|
# self.notify_collections_staff(bill)
|
|
#
|
|
# def complete_collections(self, activation):
|
|
# """Finalize the collections process"""
|
|
# process = activation.process
|
|
# bill = process.medical_bill
|
|
#
|
|
# # Mark process as completed
|
|
# process.collections_resolved = True
|
|
# process.save()
|
|
#
|
|
# # Send completion notifications
|
|
# self.notify_collections_completion(bill)
|
|
#
|
|
# def end_collections(self, activation):
|
|
# """End the collections workflow"""
|
|
# process = activation.process
|
|
#
|
|
# # Generate collections summary
|
|
# self.generate_collections_summary(process.medical_bill)
|
|
#
|
|
# # Helper methods
|
|
# def notify_collections_staff(self, bill):
|
|
# """Notify collections staff"""
|
|
# collections_staff = User.objects.filter(
|
|
# groups__name='Collections Staff'
|
|
# )
|
|
#
|
|
# for staff in collections_staff:
|
|
# send_mail(
|
|
# subject=f'Collections Account: {bill.bill_number}',
|
|
# message=f'Account for {bill.patient.get_full_name()} requires collections action.',
|
|
# from_email='collections@hospital.com',
|
|
# recipient_list=[staff.email],
|
|
# fail_silently=True
|
|
# )
|
|
#
|
|
# def notify_collections_completion(self, bill):
|
|
# """Notify collections completion"""
|
|
# # This would notify relevant parties
|
|
# pass
|
|
#
|
|
# def generate_collections_summary(self, bill):
|
|
# """Generate collections summary"""
|
|
# # This would generate collections summary
|
|
# pass
|
|
#
|
|
#
|
|
# # Celery tasks for background processing
|
|
# @celery.job
|
|
# def auto_generate_bills():
|
|
# """Background task to automatically generate bills"""
|
|
# try:
|
|
# # This would generate bills for completed services
|
|
# return True
|
|
# except Exception:
|
|
# return False
|
|
#
|
|
#
|
|
# @celery.job
|
|
# def monitor_claim_status():
|
|
# """Background task to monitor insurance claim status"""
|
|
# try:
|
|
# # This would check claim status with insurance companies
|
|
# return True
|
|
# except Exception:
|
|
# return False
|
|
#
|
|
#
|
|
# @celery.job
|
|
# def generate_billing_reports():
|
|
# """Background task to generate billing reports"""
|
|
# try:
|
|
# # This would generate daily billing reports
|
|
# return True
|
|
# except Exception:
|
|
# return False
|
|
#
|
|
#
|
|
# @celery.job
|
|
# def auto_post_insurance_payments():
|
|
# """Background task to automatically post insurance payments"""
|
|
# try:
|
|
# # This would post insurance payments from EDI files
|
|
# return True
|
|
# except Exception:
|
|
# return False
|
|
#
|
|
#
|
|
# @celery.job
|
|
# def identify_collection_accounts():
|
|
# """Background task to identify accounts for collections"""
|
|
# try:
|
|
# # This would identify overdue accounts
|
|
# return True
|
|
# except Exception:
|
|
# return False
|
|
#
|